Abstract The objective of the proposed research is to develop more rigorous electronic health record (EHR) downtime procedures to improve patient safety, quality of care and organizational processes. The research team will first use archival data, observations, and interviews to compare workflow procedures under normal conditions and during EHR downtimes. This analysis will provide quantitative information on the impact of EHR downtimes. This information will also serve as a foundation for computer simulation models that the research team will develop to design improved downtime procedures for use in specific clinical contexts. This project utilizes the extensive expertise of the research team in human factors, health information technology, industrial engineering and computer simulation. The proposed research is based on unique insights that our team gleaned from observing clinical care processes during EHR downtimes. This research effort is being conducted in partnership with MedStar Health, a ten-hospital system. Contributions from this research will include a fundamental understanding of EHR downtime processes. Critically, our research will begin to introduce the rigorous computational simulation approach to EHR downtime planning. The proposed research is responsive to Special Emphasis Notice NOT-HS-15-005, which announced AHRQ's interest in funding research on health IT safety.